Atypically located submandibular gland diagnosed by Doppler ultrasound

The anatomical location and relationships of the submandibular gland are well-known to most otolaryngologists and gross variations from the norm are rare. We report a case of an atypical submandibular gland located 2 cm below the mandible which presented as a painful neck swelling with non-diagnostic fine needle aspiration cytology. Using Doppler ultrasound the mass was noted to be closely located to the facial artery and vein and following the administration of oral lemon juice, the peak systolic velocity of a small artery within the mass rose from 8.5 cm/s to 16.4 cm/s, confirming the tissue's salivary nature. We review the literature on using Doppler ultrasound in this area of the neck and discuss realistic practical applications of the technique.